Electronic health records and outpatient cardiovascular disease care delivery: Insights from the American College of Cardiology's PINNACLE India Quality Improvement Program (PIQIP)

Abstract

Background: There has been a push toward implementation of electronic health records (EHRs) in federally-funded hospitals under the current policies initiated by the Indian government, with a lack of evidence supporting their adoption. We analyzed data from the American College of Cardiology's PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP) to evaluate the association between EHR use and quality of cardiovascular disease care in India.

Methods and results: Between 2011-2016, we collected data on performance measures for patients with coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (AF) among 17 participating practices in PIQIP. There were 19,035 patients with CAD, 9,373 patients with HF, and 1,127 patients with AF. Documentation of co-morbidity burden in patients with CAD was lower among practices with EHR-hypertension (49.8% vs. 52.1%, p=0.003), diabetes (34.9% vs. 38.3%, p<0.001), and hyperlipidemia (0.2 vs. 3.9%, p<0.001). On the contrary, documentation of medication prescription was higher in CAD patients seen at practices with EHR-aspirin (63.2% vs. 17.8%, p<0.001), clopidogrel (41.7% vs. 27.4%, p<0.001), beta-blockers (61.4% vs. 9.8%, p<0.001), and ACE-i or ARBs (53.9% vs. 16.4%, p<0.001). Similarly, documentation of receipt of beta-blockers (43.8% vs. 10.7%, p<0.001), ACE-i or ARBs (40.8% vs. 16.1%, p<0.001), and beta-blockers+ACE-i or ARBs (36.4% vs. 3.6%, p<0.001) was also significantly higher in patients with HF seen at practices with EHR. Among patients with AF, documentation of oral anticoagulation use was significantly higher among EHR practices-warfarin (42.5% vs. 26.1%, p<0.001).

Conclusions: Documentation of receipt of guideline-directed medical therapy in CAD, HF, and AF was significantly higher in practices with EHRs in India compared with sites without EHRs. Our findings shed a spotlight on the value of EHRs in future health care policy-making in India with regard to widespread adoption of EHRs in primary and advanced specialty care settings across public and private sectors.

Keywords: American College of Cardiology; Cardiovascular care; Electronic health record; India; Quality improvement.